1. “Preparing Our Communities” Welcome!

2. Faculty Disclosure • For Continuing Medical Education (CME) purposes as required by the American Medical Association (AMA) and other continuing education credit authorizing organizations: • In order to assure the highest quality of CME programming, the AMA requires that faculty disclose any information relating to a conflict of interest or potential conflict of interest prior to the start of an educational activity. • The teaching faculty for the BDLS course offered today have no relationships / affiliations relating to a possible conflict of interest to disclose. Nor will there be any discussion of off label usage during this course.

3. Rapid Evaluation of a DISASTERThe R.E.D. Survey A review of the NDLS principles

4. Objectives • List the three steps of the R.E.D. Survey • Describe the Incident Survey • Discuss the DISASTER paradigm • List the action steps of MASS Triage • Describe the Casualty Survey

5. R.E.D. Survey The Rapid Evaluation of a DISASTER consists of three steps: • Step 1: Incident Survey • Step 2: MASS Triage • Step 3: Casualty Survey

6. Step1: Incident Survey Incident “ABCDE exam” A = Aware B = Barrier C = Communicate D = D.I.S.A.S.T.E.R. E = Enter (Exit) Before Patient Care Initiated!

7. DISASTER Paradigm D Detection I Incident Management S Security A Assess Hazards S Support T Triage / Treatment E Evacuation R Recovery Does your need exceed your resources in any of these areas?

8. D-I-S-A-S-T-E-R ParadigmDetection • Awareness that resources are being overwhelmed • Is Need > Resources? Yes is a disaster! • Requires knowing your capabilities and capacities, right here “local”, right now! • Detection of potential cause of the event • Not all disasters are obvious • (e.g. biological vs. Chemical, etc)

9. D-I-S-A-S-T-E-R Paradigm Incident Management • National Incident Management System (NIMS) • Provides orderly chain of command • Clearly defined roles, responsibilities and lines of communication • Who is the incident commander?

10. D-I-S-A-S-T-E-R Paradigm Safety & Security • Identify and mitigate obvious threats to Safety and Security • Secondary devices? (e.g. second bomb) • Ongoing action by perpetrator? • Power lines, gas leaks, building collapse • Crowd surge from patients, families, media • Time of day • Weather forecast, etc.

11. D-I-S-A-S-T-E-R ParadigmAssess Hazards • Priority One • Protect yourself and your team first! • Don’t become part of the problem! • Utilize personal protective equipment • Medical decontamination methods • Your next priorities • Protect the public • Protect the patients • Protect the environment • Avoid tunnel vision on the ill and injured

12. D-I-S-A-S-T-E-R ParadigmSupport • What resources are needed? • Who has them? • Local • Regional • State • Federal • When will they arrive? • Minutes, Hours, or Days

13. D-I-S-A-S-T-E-R ParadigmTriage • M.A.S.S. Triage System M – Move A – Assess S – Sort S – Send

14. D-I-S-A-S-T-E-R ParadigmTreatment • Treatment continues until: • All patients transported to healthcare areas • Resources unavailable to provide treatment • Comfort is Care! • Treatment locations • Scene, hospitals, secondary treatment areas • Documentation • Patient Identification / Triage Tag • Medical Record

15. D-I-S-A-S-T-E-R ParadigmEvacuation • What is your route? • Patient evacuation from scene to hospital or treatment area • Consider routes, vehicles, staging areas • Public evacuation of elderly, poor, nursing homes, etc. • Special needs patients • Hospital evacuation during a catastrophic event • Flooding, power outages • Facility contamination • Essential part of your plan!

16. D-I-S-A-S-T-E-R Paradigm Recovery • Long-term goal of the event! • Minimize event’s impact • Injured victims, families, rescue personnel • Community, state, and nation • Environment • Preparedness Plan must include • Begins… when the incident occurred • Ends… often years later

17. Step1: Incident Survey Enter Or Exit Aware Barrier Communicate DISASTER

18. Step 2: MASS Triage • Grouping, then sorting patients • Determine the seriousness of their injuries / illness and the likelihood of their survival • To achieve the greatest good for the greatest number possible • Dependent on resourcesavailable

19. Triage Categories • “ID-me”!“Identify Me” • A mnemonic for sorting patients during triage I – Immediate D – Delayed M – Minimal E – Expectant D -DEAD

20. Triage Categories • Triage category decision making is dependant upon these three variables? • Injury / illness • Is a life, limb, or vision threatening condition present? • Intervention • Can I perform the needed medical intervention on this patient? • Transportation • When can I transport this patient?

21. Step 2: M.A.S.S Triage • Move • Anyone who can walk is told to MOVE to a collection area • Remaining victims are told to MOVE an arm or leg • Assess • Remaining patients who didn’t move (help these first) • Sort • Categorize patients by “ID-me” • Immediate, Delayed, Minimal, Expectant, Dead • Send • Transport IMMEDIATE patients first • Send to Hospitals and Secondary Treatment Facilities

22. Triage Documentation • Medical record • It is often the only medical record available on the patient • Communication • Vital, often only, link to information • Identification • History & Physical • Treatment • Old medical records • Contact information • Personal message

23. M.A.S.S Triage Key Principle of MASS Triage: • Group, …then Sort, …then Transport!

24. Step 3: Casualty Survey Early patient assessment during a mass casualty incident includes: A: Airway B: Breathing C: Circulation D: ? E: ?

25. Step 3: Casualty Survey Early patient assessment during a mass casualty incident includes: A: Airway B: Breathing C: Circulation D: Differential Dx, Detection & Delivery E: ?

26. Step 3: Casualty Survey D: Differential Dx, Detection & Delivery: • What could be causing this casualty? • What antidote or intervention needed? • Head & Neck: • Pupils, Secretions, Neuro, Tenderness, Trauma • Chest: • Breathing, Heart R&R, Tenderness, Trauma • Abdomen: • Pain, N&V, Diarrhea, Tenderness, Trauma

27. Step 3: Casualty Survey Is a life-saving medical or surgical intervention needed? • Airway: • Manual, ET Intubation, Needle Cricothyroidotomy • Breathing: • Needle Decompression • Circulation: • Uncontrolled bleeding management, • Pericardiocentesis • Detection of agents and antidote delivery

28. Step 3: Casualty Survey Early patient assessment during a mass casualty incident includes: A: Airway B: Breathing C: Circulation D: Differential Dx, Detection & Delivery E: Evaluate or Evacuate (Exit)

29. Step 3: Casualty Survey Evaluate Or Evacuate (Exit) Airway Breathing Circulation DDx Detection Delivery

30. R.E.D. Survey • Completed the Rapid Evaluation of a DISASTER • Step 1: Incident Survey • Step 2: MASS Triage • Step 3: Casualty Survey

31. Summary Now you can: • List the three steps of the R.E.D. Survey • Describe the Incident Survey • Discuss the DISASTER paradigm • List the action steps of MASS Triage • Describe the Casualty Survey

32. Thank You! Questions?

33. Contact information Ray E. Swienton, MD, FACEP Co-Director, EMS, Disaster Medicine & Homeland Security Section Division of Emergency Medicine, Department of Surgery University of Texas, Southwestern Medical Center at Dallas 5323 Harry Hines Blvd. Dallas, Texas 75390-8579 Email: BearDogMD@AOL.com Voice: (817) 271-7801

34. Last Slide • Intentionally blank